HomeMy WebLinkAboutMortgage_Hyatt�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Y ar
�+ w� J -SUte Fwm a3709 (RS l 4-03) ���`�\ ��1 n
� PresaiEeO by Department of Loral Govemment Finarwe � $ f � ���
iNSrRUCnoNS: MAR 1 4 ��(�7a�
To be �led in person or by mail with the Counry Auditor of fhe county where the property is located.
Filing Dates: 1) Real Property: Dunng the 1? months 6efore May 11 of the year the deduction is to be`�ct�e.,Q�,
2) Mobife Homes assessed under IC 6-7.1-7: Between January 15 and March 2 0/ the year the�eductio�n is to 6e eBective.
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicanl
Taxing
contract
U/L�`{/ �%
see
Assess8d value oi real property as of
March 1, current year
no, what is his / her exaa share of inlerest?
an
K number / legal descripti Record number ��
a10-/l-/7'�`00_p 1.7/8�f-Od/
/'n� /� / � �,G,L � Page number /
� C/ � �
Mortgage / Contrect indebtedness unpaid as of Is the applican he sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
�� ��
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
/me of mortgagee or contract seller
� 7/ /
Addre�� �! �*+��+�a�PP nr rnntrad seller fnumber.and s6eet, city, si
Name
Addre:
Does a
county
Deduc
20 I
Signat
�
i�� ��" � T D A��'v%
A-�G�L�
�- 8�.��
�
��� 3, Svo `�
s
� Taxing Districl?
rort
20
�,�iG���
s the property in question:
❑ Real Property ❑ Mobile Home (IC Cr1.
Has this dedudion been requested on
property for current year? � Yes � No
20
Date
20
mation is true and corred and that the applicants was / were
. za
on authorized by duly executed Power of Attomey
.., u� IC 6-1.1-12-.07
of authonzed person